Dr Sam Gartland is a GP based in Ballina NSW. In 2008 he was diagnosed with relapsing-remitting MS. Through evidence-based lifestyle changes, including a whole food plant-based diet, Sam has achieved a full recovery, and is now an active advocate for these approaches to be at the centre of MS patient care. On World MS Day, Sam shares the empowering science behind his own recovery and explains why more dietary studies should be a priority in MS research.
What is Multiple Sclerosis?
MS is considered to be an autoimmune, degenerative and progressive disease of the central nervous system (brain and spinal cord). The resulting symptoms can manifest throughout the body, including motor impairments from weakness and spasms to paraplegia, optic neuritis, bladder and bowel dysfunction, as well as intense fatigue and cognitive decline over time.
MS is the commonest disabling disease of young adults affecting 25,607 people in Australia – an increase of around 20% between 2010-2017. 
It is a devastating disease with a large number (up to 58%) unable to retain employment following diagnosis  and 75% ceasing work within 10 years of diagnosis. 
Nurture before nature
Studies of identical twins have demonstrated that genes contribute 25% to the risk of developing MS.  The stronger the genetic background risk the earlier the onset of MS.  Of importance to PwMS (People with MS) and their treating doctors is the finding that genetics has little role to play in disease progression and outcomes in MS.
The largest genetic study of PwMS, The International MS Genetics Consortium study, looked at the genome of 9772 PwMS and found, “no evidence for genetic associations with clinical course, severity of disease or month of birth, and no evidence of interaction with gender…”
The largest meta-analysis of established MS genetic risk variants and disease severity found no effect of genes on clinical outcomes over the longer term (10 + years).
A smaller (n=127) study did show an up to 30% effect of genes on disease progression in the first 5 years of the disease.
It is clear that environmental and lifestyle factors are the main drivers of MS.
It is clear that environmental and lifestyle factors are the main drivers of MS. Fortunately there is a lot known about these risk factors. The known environmental and lifestyle factors include:
A Western diet high in saturated fats and low in Omega 3s [9, 10]
Cow’s milk exposure [11, 12]
Viral infections (EBV, HHV) 
Low Vitamin D and sunlight exposure [14, 15]
Smoking [16, 17, 18]
Stress [19, 20, 21, 22]
Shift work [23, 24, 25]
Therefore, just as with other modern chronic conditions, any comprehensive treatment program has to address these modifiable risk factors.
The lifestyle prescription
In 1948 the Neurologist Prof Roy Swank recognised the association between animal fat consumption and the incidence of MS. This prompted him to set up a remarkable 34 year study that investigated the effect of a low saturated fat diet in MS. Publishing his work in The Lancet in 1990 he demonstrated that those that adhered to this diet (regardless of disability at the beginning of this study) stabilised the disease with little or no progression of disability and survived for the duration of the study. Those that didn’t keep to the dietary changes significantly deteriorated with the majority being dead at the end of the study.[26, 27]
Little was made of this study until the work of Professor George Jelinek, a Professor in Emergency Medicine. He developed MS himself and went back through the literature to develop a comprehensive lifestyle intervention program to manage MS. In 1999 he developed the “Overcoming MS Program” (OMS).
This approach advocates:
Adopting a plant-based diet that avoids dairy and altered fats (allowing seafood if desired)
Supplementing with flaxseed
Maintaining a Vitamin D level at 150-225nmol/L
Those following this program demonstrate significant improvements within 1 year: improved mental health 12%, physical health 19%, and overall quality of life 11%.  These changes are sustained and increase over a 5-year period with improvements in: mental health 23%, physical health 18%, and quality of life 20%.
Since this time there has been an abundance of data supporting the steps that Professor Jelinek has advocated. For example, the HOLISM study surveyed over 2500 PwMS in 57 countries and found that those following the steps of the OMS program had better health outcomes: Less disability, fewer relapses , better quality of life , and less incidence of depression  and fatigue. 
Exercise has also been well documented to improve quality of life and function  and immunological markers in PwMS.  A new RCT showed that resistance training can have a neuro-regenerative effect with increases in cortical thickness. 
The nutrition connection
While more dietary studies are needed, the existing evidence has shown a consistent link between saturated animal fat intake and MS. [38-43] Observational studies have additionally found that PwMS had lower antioxidant blood levels than people without MS, indicating that eating a plant-based diet high in antioxidants may also be protective against MS. 
So far, there has been one pilot RCT of a plant-based diet in PwMS that ran for 1 year. This did not demonstrate significant improvements on disease activity or MRI, which aligns with Swank’s findings that it takes up to 5 years to achieve disease stability. However, patients in the pilot did experience improvements in fatigue, BMI and metabolic biomarkers, which represents a significant improvement in quality of life. 
Further long-term RCTs are needed to develop our understanding of the diet/MS connection, but what we know so far strongly indicates that whole food plant-based diets are effective for both prevention and mitigation of MS.
Having experienced my own recovery journey, I am committed to advocating for healthy diet and lifestyle: this includes updating medical training and putting lifestyle and diet research at the forefront of MS research.
Healthy diet and lifestyle must be at the forefront of our approach to preventing and treating MS, with whole food plant-based nutrition as a central pillar
The take-home message
The understanding of the causes and (non-drug) treatment interventions for MS has increased greatly. PwMS and their treating health professionals now have a large and congruent evidence base on which to plan their treatment. The tertiary prevention of MS must include comprehensive lifestyle changes to optimise outcomes. This has finally been recognised by Neurologists. The January 2018 editorial of the Journal Neurology declared:
“encouraging a healthy lifestyle (healthy eating, a normal weight, routine physical activity or exercise, and avoiding smoking) should be a fundamental message we give to all newly diagnosed patients with MS.”
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About the author
Dr Sam Gartland is a GP based at The Clinic, East Ballina. He was diagnosed with relapsing-remitting MS in 2008. In January 2009 he attended an Overcoming MS program run by Professor George Jelinek at the Gawler foundation. By following this program he managed to return to work full time and has remained relapse free. The lesions on his MRI scan resolved and he now feels in the best shape of his life. His recovery is in line with the published results of the OMS program. His story and others can be found in the book,